Hospital response to story raises questions

An article that appeared in The Smoky Mountain News opinion section two weeks ago based on an anonymous interview with several nurses from the Haywood Regional Medical Center Emergency department prompted a rebuttal from hospital employees last week.

Around 350 hospital employees signed a statement denouncing what the nurses had said about conditions in the Emergency Department. The statement ran as an ad in The Mountaineer, featuring all the names of hospital employees who signed it. The names amount to about one-third of hospital employees. The idea for the statement originated solely with employees, who circulated it themselves, and took up a collection to pay for the ad, according to hospital spokesperson Robin Tindall-Taylor.

Some are questioning whether employees felt forced to sign the statement when asked to by their boss, however.

“It is hard to imagine if you didn’t sign something like that how would it not have an adverse affect on your job,” said Dr. Eli Zaslow, a former ER doctor. “It bears no weight whatsoever. Whatever signatures they get are going to be bogus because the employees are under pressure and afraid of losing their jobs.”

Zaslow’s group of doctors, Haywood Emergency Physicians, was ousted in December despite having two years left on its contract. The group is suing the hospital for breech of contract. Zaslow, who now works at Hazelwood Family Practice, said he heard accounts of the statement being circulated through the hospital and of employees feeling compelled to sign it.

Instead of acknowledging the underlying issues causing dissatisfaction in the medical community and among nurses, the hospital instead is trying to address the public relations problem, Zaslow said.

“They are trying to propagate the concept that there is no dissatisfaction,” Zaslow said.

A hospital van with several employees even hand-delivered a copy of the statement and signatures to one county commissioner.

Ellen Sither, who worked at the Haywood Regional Medical Center Foundation until quitting her job last week, also heard accounts from employees who felt forced to sign the statement regardless of whether they agreed with it.

“I think half those signatures were very willing and supportive of administration. I would say half of them felt like they had to sign it. I know one department was told they had to sign it,” Sither said.

Sither is the wife of one of the former ER doctors. She worked at the Foundation until last week, when she finally felt compelled to resign.

“Not because the hospital is a bad place, but because the leadership is unethical,” Sither said. “It disturbs me.”

Sither spent the past six months at the Hospital Foundation as a hospital booster, raising donations and applying for grants for a new surgery center and a hospice facility. Like many in the medical community who are dissatisfied with HRMC CEO David Rice, Sither differentiates between the politics of hospital administration and the quality of care provided by the hospital and medical community in Haywood County.

“There’s wonderful, wonderful things about that hospital that go on despite the administration,” Sither said. “If the community doesn’t support the hospital we’re all in trouble.”

Sither said one statement by the ER nurses that appeared in the interview was likely the tipping point that prompted so much ire. The nurses questioned whether they would take their own family members to Haywood’s ER if they had a serious medical emergency. At the time of the interview, the ER was being run by a revolving door of out-of-town doctors brought in to cover shifts after the old doctors were fired. Sither said that although that statement was unfortunate, she can understand where the nurses were coming from.

“They had a chaotic situation that wasn’t being paid attention to for them,” Sither said. “I think it was just masking a much deeper problem with the nurses, which is they don’t feel safe to express themselves or feel supported in their views at all. It is a culture of fear at the hospital.”

Sither said whenever nurses have expressed concerns or issues to administration, they are told “there is a stack of applications if you want to leave.”

Is change coming?

Following the anonymous interview that appeared in The Smoky Mountain News, nurses who work in the ER were called to a mandatory meeting. Nurses from other floors of the hospital were pulled in to cover shifts in the ER so all the ER nurses could be at the meeting.

The ER nurses were fearful going into the meeting, according to those familiar with the matter. Instead of being chastised, however, nurses were asked to share their concerns. Many were hesitant to do so, but it seems to be a first step, Sither said. None of the roughly 20 ER nurses signed the statement.

“I am optimistic that the meeting between the nurses and the administration went well and that maybe this will be the beginning of a different culture at the hospital. I am anxious to see the follow through,” Sither said.

Sither said her own personal life was devastated by the hospital administration. She is now having to leave a community and town she loves and move to another state where her husband got a new job as an ER doctor.

“I don’t want to leave Waynesville,” Sither said. One thing that could make it more palatable is if their tribulations lead to change.

“I hope some real lessons are learned,” Sither said. “We all want to see it get better. That will be the silver lining.”

A month prior to printing the anonymous interview with nurses, The Smoky Mountain News provided hospital CEO Rice with a copy of the interview and asked him to respond on behalf of the hospital. Rice declined to respond to any of the issues raised by the nurses. Unable to provide both sides due to the lack of a response, the paper printed the interview on the opinion page.

Operating out of fear

Dr. Mike Rey, another former ER doctor, said the statement was an example of “strong-arm tactics” that are part of the administration’s operating style.

“I’m sure they all felt like they had to sign this or they would be fired. Everyone not on this list is the black list,” Rey said of the statement. “How is that not coercion?”

Although formerly an ER doctor with Haywood Emergency Physicians, Rey was not around when the group was fired last December. Rey had parted ways with his partners six months prior. Rey, who helped start the group 15 years ago, said he left the group because of internal problems.

Rey has remained silent during the controversy between his former group and the hospital administration until now. Rey saw plenty of fault on both sides in the conflict.

But his heart now lies with the nurses. Rey said he was prompted to speak out after reading the anonymous interview by the nurses. Even though it was anonymous, the nurses took a big risk to share the concerns, he said.

“All the employees have had their jobs threatened,” Rey said.

More and more, nurses are leaving Haywood Regional, especially the ER, Rey said. Rey said the hospital has short-changed the number of nurses needed in the ER.

“It’s hard work. It’s confusing and hectic, and it gets busier every day,” Rey said. The nurses, under-paid and under-staffed at Haywood, leave for other hospitals, he said. The hospital is a revolving door for nurses fresh out of school.

“We keep retraining brand new nurses. They come to Haywood and get their two years experince and then they can go to any ER they want to,” Rey said. “Those left are the nurses who have been here years and years who are teaching all the new ones how to do it.”

Rey said the nurses are the lifeblood of a hospital, especially in an ER.

“The ER won’t really work well until they have enough nurses,” Rey said.

Things got worse instead of better when the hospital opened its new ER two years ago, Rey said.

“When this new ER was built, the people were promised a state of the art ER. That’s how it was sold to the public but the public didn’t get that,” Rey said. “What Mr. Rice does is build things you can see. You can see the building and see there’s a brand new facility, but when it comes to the inner workings of the place, he skimps to make it look better. You need more nurses to cover more space. Rather than have a enough nurses we have LCD screens.”

It’s not just pay and numbers that make life bad for the nurses, Rey said. They feel like they aren’t supported or valued by administration, he said

The statement signed by employees chastised the nurses who participated in the anonymous interview for “not going through the established process” to have their issues addressed.

Rey said nurses have tried many times to go through proper channels with their job concerns.

“They have tried to use the established process and they have been ignored,” Rey said. Rey tried to use the proper channels himself to share concerns about nurse staffing in the ER.

Rey wrote a short report explaining some of the problems faced by nursing in the ER to the hospital board. Rey got a two-sentence letter from hospital board chairman Dr. Nancy Freeman thanking him for the letter and stating the board would discuss his concerns in closed session. Rey never heard back.

Editor’s note: The copy below is an excerpt from an ad that was published in The Mountaineer on May 4 and May 7. The ad refers to an April 25 story in The Smoky Mountain News titled “Haywood nurses frustrated by changes.” The story was an interview with five HRMC Emergency Department nurses about their feelings on changes in the ED. The nurses were quoted anonymously.

We, the undersigned employees of Haywood Regional Medical Center, wish to share with the Western North Carolina community our concern regarding the comments expressed recently through media other than The Mountaineer. This article, we believe, expresses the views of a few “alleged” employees of the medical center. These opinions do not reflect the views of the vast majority of the medical center employees. These derogatory views have been expressed behind the veil of anonymity and it is unfortunate that these individuals did not utilize the established processes for addressing their concerns.

These inaccurate remarks are offensive to the employees who are committed and dedicated to providing personalized, compassionate and dedicated to providing personalized, compassionate and quality healthcare to our community. For these reasons we have decided to initiate a response to speak out on this issue and support "our" Medical Center.

Healthcare is an ever changing environment. It takes great courage for the Administration and the Hospital Authority of the Medical Center to make the decisions that keep HRMC on the leading edge of healthcare. Without constant change we cannot continue to improve the quality of patient care we provide to our community.

... The use of this forum prevents us from including an exhaustive list of accomplishments, which are numerous. These changes have been put in place to enhance the quality of patient care and increase the availability of services to our community members.

In closing, we would like to restate the opinion of the dedicated and quality employees of HRMC that, “We the employees of HRMC utilize and would highly recommend to you, the community, our family and friends, to choose HRMC as your provider of choice for healthcare.”

We challenge members of the community who have had a positive experience at the medical center to speak out in support of our facility to help us change this unfounded portrayal of our Hospital!

The Naturalist's Corner

I had originally intended to spend today (Monday, Feb. 16) doing a couple of short surveys for the annual Great Backyard Bird Count. But Sunday morning amid more and more (and more and more dire) weather forecasts warning of some pretty heavy winter weather coming our way I began to contemplate counting Sunday instead. Around 9 a.m. Sunday I peeked out the downstairs window. Well, in my yard were 17 wild turkeys. It looked like a large group of jakes and gobblers.